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Emergency Medical Minute


Nov 26, 2018

Author: Nick Hatch, MD

Educational Pearls:


  • Quick review on typical treatments for acute CHF:
    • Nitrates are a mainstay to reduce preload
    • Furosemide has fallen out of favor in regards to urgency but still essential; it can also be utilized in those with poor renal function
  • Before going into the weeds:
    • Phlebotomy can be used to remove volume and may be helpful in certain clinical scenarios
    • Trapping venous blood by using blood pressure cuffs on three of four extremities was a very early treatment of CHF



Alzahri MS, Rohra A, Peacock WF. Nitrates as a Treatment of Acute Heart Failure. Card Fail Rev. 2016 May;2(1):51-55. doi: 10.15420/cfr.2016:3:3. PubMed PMID: 28785453; PubMed Central PMCID: PMC5490950.

Paterna S, Di Gaudio F, La Rocca V, Balistreri F, Greco M, Torres D, Lupo U, Rizzo G, di Pasquale P, Indelicato S, Cuttitta F, Butler J, Parrinello G. Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure. Adv Ther. 2015 Oct;32(10):971-82. doi: 10.1007/s12325-015-0254-9. Epub 2015 Oct 31. PubMed PMID: 26521190; PubMed Central PMCID: PMC4635178.

Huijskes RV, Hoogenberg K, Wiesfeld AC, Pijl ME, van Gelder IC. Phlebotomies as a treatment of serious heart failure due to haemochromatosis: a case report. Neth Heart J. 2009;17(11):438-41.

Burch, George E., and Nicholas P. DePasquale. "Congestive Heart Failure—Acute Pulmonary Edema." JAMA 208.10 (1969): 1895-1897.


Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD